髋关节翻修术后输血的危险因素分析及列线图预测模型建立

An analysis on the risk factors of blood transfusion after hip revision and establishment of a nomogram prediction model

目的探讨髋关节翻修患者围手术期输血的危险因素,为临床上早期筛选术后高风险输血患者提供指导意义。方法纳入自2012年8月至2021年3月行髋关节翻修术的162例患者,根据术后是否输血分为输血组88例,未输血组74例,输血率54.32%。收集两组患者年龄、性别、BMI、高血压、糖尿病、骨质疏松、术前红细胞、术前血红蛋白、术前血小板、术前PT、术前APTT、术前INR、术前TT、术前血钙、术前白蛋白、ASA评分和术后异体输血等资料,利用SPSS软件进行多因素二元logistic回归分析髋关节翻修患者术后输血的危险因素;通过R软件(4.1.1)构建列线图预测模型,并绘制出ROC曲线及校准曲线来评价模型的区分度和标准度。结果多因素二元logistic回归分析显示,高血压(OR=2.249,P=0.037)和骨质疏松(OR=3.927,P=0.001)、术前血红蛋白(OR=0.255,P=0.026)和术前血钙水平(OR=0.338,P=0.038)是髋关节翻修患者术后输血的危险因素。通过R软件构建列线图预测模型并绘制出ROC曲线及校准曲线,得到曲线下面积(AUC)为0.751,校准曲线斜率接近1,表明该预测模型预测术后输血风险具有较好的区分度和准确度。结论基于高血压、骨质疏松、术前血红蛋白以及术前血钙这四项独立危险因素建立的列线图预测髋关节翻修患者术后输血风险具有较好的区分度和准确度。

Objective To investigate the risk factors of perioperative blood transfusion in patients undergoing hip revision,and to provide guidance for early screening the patients at high risks of postoperative blood transfusion.Methods A total of 162 patients who had undergone hip revision surgery during the period from August 2012 to March 2021 were included in this study.They were divided into a transfusion group(88 patients)and a non-transfusion group(74 patients)according to whether they received blood transfusion,with a transfusion rate of 54.32%.The data on age,gender,BMI,hypertension,diabetes,osteoporosis,preoperative red blood cells,preoperative hemoglobin,preoperative platelets,preoperative PT,preoperative APTT,preoperative INR,preoperative TT,preoperative blood calcium,preoperative albumin,ASA score and postoperative allogeneic blood transfusion were collected from both groups.The SPSS software was used to analyze the risk factors of postoperative blood transfusion in patients with hip revision.The R software(4.1.1)was used to build a nomogram prediction model,and the ROC curve and calibration curve were drawn to evaluate the differentiation and standard degree of the model.Results Multivariate binary logistic regression analysis showed that hypertension(OR=2.249,P=0.037),osteoporosis(OR=3.927,P=0.001),preoperative hemoglobin(OR=0.255,P=0.026)and preoperative blood calcium levels(OR=0.338,P=0.038)were risk factors for postoperative blood transfusion in hip revision patients.R software was used to construct a nomogram prediction model and draw a ROC curve and a calibration curve.The area under the curve(AUC)was 0.751,and the slope of the calibration curve was close to 1,indicating that the prediction model had good differentiation and accuracy in predicting the risks of postoperative blood transfusion.Conclusions The nomogram has better differentiation and accuracy in predicting the risks of postoperative blood transfusion in hip revision patients,which is established based on five independent risk factors including hypertension,osteoporosis,preoperative hemoglobin and preoperative blood calcium.